Treatment for subtrochanteric fracture and subsequent nonunion in an adult patient with osteopetrosis:A case report and review of the literature  

作　　者：Hao Yang Guo-Xi Shao Zhen-Wu Du Zheng-Wei Li 

机构地区：[1]Department of Orthopedics,The Second Hospital of Jilin University,Changchun 130041,Jilin Province,China [2]Departments of Orthopedics,The Second Hospital of Jilin University,Changchun 130041,Jilin Province,China

出　　处：《World Journal of Clinical Cases》2021年第35期11007-11015,共9页世界临床病例杂志

摘　　要：BACKGROUND As a congenital metabolic bone disease caused by defective osteoclastic resorption of immature bone,osteopetrosis is characterized by diffused sclerosis of bones,brittle bones,easy fracturing,narrow medullary canals,and a weak fracture healing ability.At present,clear standards and principles for the treatment of fractures in patients with osteopetrosis are lacking.Non-operative treatment can prevent fracture hematoma and preserve the blood supply to the bone fragments,while being associated with frequent failures and higher mortality rates.Meanwhile,closed reduction and internal fixation with intramedullary nail(CRIF+IMN)approaches can also protect blood supply to the fracture site.However,IMN cannot be used for the vast majority of patients with osteopetrosis due to the narrowing of medullary canals.Thus,open reduction and internal fixation with plate remains the most appropriate surgical method for treating fractures in patients with osteopetrosis,but this approach is complicated by the lack of intramedullary hematopoiesis in such patients.Fracture healing primarily depends on the blood supply to the external periosteum.Open reduction can also easily destroy the periosteum and cause delayed fracture healing or even nonunion;however,CRIF may be the most practical approach.As a result,it would be prudent to solve the difficulty of drilling during the operation and the problem of postoperative nonunion.CASE SUMMARY In 2018,we treated an adult patient with osteopetrosis presenting with a subtrochanteric fracture.The fracture was fixed using a femoral locking compression plate.Because of delayed consolidation,at 12 mo postoperatively the patient was further treated with platelet-rich plasma(PRP)combined with radial extracorporeal shock wave therapy(rESWT).Antero-posterior and lateral radiographs obtained at the latest follow-up(10 mo)showed that the callus had grown at the original fracture site,and the medial fracture line almost disappeared.CONCLUSION Osteosynthesis remains the first choice of treatmen

关 键 词：OSTEOPETROSIS Subtrochanteric fracture NONUNION Platelet-rich plasma Radial extracorporeal shock wave therapy Case report 

分 类 号：R687.3[医药卫生—骨科学]